A Long-Term Complication with Increasing Incidence: Intravesical Hem-o-Lok® Clip Migration after Robot-Assisted Laparoscopic Radical Prostatectomy

Background: Hem-o-lok® clips (HOLC) (Weck Surgical Instruments, Teleflex Medical, Durham, NC) are commonly used to achieve athermal hemostasis and control the lateral vascular pedicles of the prostate, especially in nerve-sparing surgery during robot-assisted laparoscopic radical prostatectomy (RALP). However, an increasing number of studies have demonstrated intravesical HOLC migrations. This study aims to describe the clinical presentation, symptoms, management, and outcomes of intravesical HOLC migration to the vesicourethral anastomotic site (VUAS). Methodology: A retrospective analysis was conducted on 386 RALP procedures performed by an experienced surgeon at a tertiary care center between November 2017 and November 2024. The data of all patients who have experienced intravesical HOLC migration during long-term follow-up and were treated for this reason were compiled. Cystoscopy findings, HOLC localizations, the number of HOLCs removed, procedures, and patient follow-up data were analyzed. Results: Of 386 patients, 5 (1.2%) experienced intravesical HOLC migration at follow-up. Two of these patients received adjuvant radiotherapy. The mean time to identify HOLC migration was 27.8 ± 18.3 months. Following a single cystoscopic intervention, none of the patients' HOLC migration-related symptoms recurred, and no further procedures were required. During follow-up, bladder neck stenosis occurred in 2 patients. Conclusion: In long-term follow-up of RALP, the lower urinary tract symptoms and persistent dysuria may be related to intravesical HOLC migration. In surgical practice, avoiding using HOLC close to the VUAS and reducing the number of HOLC utilized may help prevent complications.